There has been a sharp rise in the number of people making contact with eating disorder charities since the start of the coronavirus lockdown almost eight weeks ago. The charity BEAT says calls to its helpline have increased by 50% and that there has been a 78% rise in contact via social media compared with February. Charities are concerned that a reduction in hospital services and a move to online sessions could result in an increase in new cases and setbacks for those with an active eating disorder or those in early recovery. Caroline Price, BEAT’s director of services, said: “It’s not surprising we’ve seen such a large increase in contact. Changes in routines, living situations and care plans have the potential to trigger eating disorders. It’s more important now than ever that those who are unwell feel supported.” Dave’s eating disorders started to return after his father died from Covid-19 six weeks ago. “At first I was in a state of constant denial,” he says. “Now I just feel really horrible in my body, like I’m losing control. Being sat around the house, surrounded by food, unable to exercise, worrying about calories … It’s been really hard to cope, to be honest.” The 31-year-old has been in recovery for four years after fast-track treatment for anorexia. He says processing the grief after his father’s death, while struggling with an eating disorder has led to a deterioration in his mental health. “I realised quite early on in lockdown that I was at risk of this all affecting my wellbeing. It’s easy to go back to focusing on things that feel safe, somehow. I missed feeling I was winning at it, seeing the scales going down. “I really feel this will give people an insight into what a restrictive eating disorder, binge eating, and even overeating, are really like. It’s this constant thinking and talking about food - it’s our only enjoyment and occupation at the moment.” Katie also feels that the pressures of lockdown have affected her recovery. In late March, after the closure of the treatment centre she attended five days a week, she returned home to isolate with her mother and younger brother. “It was really sudden,” says the 22-year-old. “There was no time to gradually reduce support. Before, I had all my meals made for me, so all the food decisions had been taken away. But now I have to make all the decisions myself, even if I don’t feel 100% ready for that.” While Katie’s treatment has moved to online video sessions, with individual appointments and a group timetable throughout the day, she is finding the disruption to her routine unsettling. “My initial thought was: ‘What’s the point? Everything’s ruined. I may as well give up now.’ I thought it was a sign, like I was going to go back to square one. I suppose it’s easy to have that snap reaction, but it does feel like an obstacle has been put in the way.” Steve Clarke is a psychotherapist at Arthur House, an eating disorder service based in south-west London which is part of the Priory Group. He says that while online support has its advantages, it also has limitations. “Online therapy doesn’t support someone with an eating disorder at critical times, such as mealtimes. The challenge isolation presents to patients is not having that hands-on, physical presence.” Medics say that mealtimes can be particularly ritualistic for those with an eating disorder, requiring a clear plan and set times. For those without a support network, maintaining structure can be difficult. Dr Joanna Silver, an eating disorder specialist for the Nightingale hospital in north London, says: “Enforced isolation has meant that many people feel disconnected from their support systems and that in turn their eating disorder is stronger. Such feelings have caused people to turn to behaviours such as bingeing, purging and restricting as a way of managing these feelings and maintaining an illusion of control.” Relapsing into unhealthy habits is more of a risk now than at any time Anna*can remember. “Living alone, I could disappear for a week and nobody would notice,” says the 28-year-old, who has been in recovery from an atypical form of bulimia for three years. “You’re only shopping for yourself; you can control how much exercise you do; and you can exclude food groups. You can be very prescriptive and it could just go unnoticed. “I know people are there if I need to talk, but I also know people are dealing with their own stuff. I find it really hard to talk about it at the best of times. It’s inexplicable outside my own head.” There are fears that food shopping and stockpiling may also add to the temptation to relapse. Without the usual selection, many feel forced to eat alternative foods. A perceived scarcity of food can, Silver says, add to the risk that some may restrict their food intake or reinforce feelings of guilt. Frequent exposure to advertisements, articles and social media posts encouraging people to get fit and lose weight are also inducing strong urges among some people with eating disorders to exercise intensely. “When I’m out walking the dog, I keep seeing loads of people running,” Katie says. “Then I go on my phone and I see all these people posting about how much exercise they’re doing. It’s everywhere.” Anna also finds the pressure surrounding exercise difficult to avoid. “I keep thinking: ‘What should I be trying to achieve? Should I be using this time to get really fit?’ Then I decided it wasn’t a time when I could get fitter or become a better athlete. I’d be lucky if I could come out of this maintaining a decent level of fitness.” Rebecca Jenning, a registered dietician at the Priory Group, says: “The sudden closure of gyms has been a source of anxiety for many people and can invoke feelings of guilt for being ‘lazy’. This shouldn’t affect what someone eats – no one should be restricting the food they eat to compensate.” Hope Virgo, a campaigner, says social media posts about exercise are pervasive. “People are posting all the time about how much sport they’re doing, influencers are promoting exercise apps, talking about their diets,” she says. “All of that fuels the fear that lockdown will make you put on weight.” Dave agrees that social media must be carefully managed. He has decided to unfollow and mute accounts that post content and share memes that may slow his recovery. “Social media at the moment just makes me feel scared and frustrated,” he says. “It’s all about self-promotion rather than actual help. I’ve learned I need to restrict the time I spend reading the news and on social media.” While for some social media posts can provoke anxiety, others welcome online groups that have been set up to offer support. The Instagram account @covid19eatingsupport runs live meal sessions for followers, encouraging them to eat a meal or snack with the support of volunteers and peers, and the @thechain recommends meal plans and live peer group meetings. Medics say setting up a new daily routine or adapting an existing schedule will be crucial to recovery, but acknowledge that the uncertainty and lack of guidance from the government regarding the reopening of support services and facilities may halt progress for some patients. For Dave, the easing of restrictions is a greater concern than the announcement of the lockdown. “I’m terrible with change. I’ve got used to living here in my glorified shoebox and choosing what I eat and drink at home. I don’t want to be in a crowded place or go to the pub. The thought of it fills me with fear.” But for Katie, looking to a future beyond lockdown is a motivating thought. “I can’t just live in a headspace where I’m thinking of throwing everything away. And I can’t sit at home wasting time and waiting. I need to try and do this at home. I need to try and move forward.” * Some of the names in this article have been changed or the person’s surname withheld at their request. The Beat Adult Helpline is open to anyone over 18. Parents, teachers or any concerned adults should call the adult helpline on 0808 801 0677.